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Donation Amount
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$1,000
$500
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$100
$50
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Donation Frequency
One Time
Monthly
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Contact Information
Name
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First Name
Last Name
Organization (if donating on behalf of an organization)
Email Address
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Address
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City
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State
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Phone Number
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I would like this donation to remain anonymous
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I will obtain a matching gift from my employer
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Employer Name
I would like to join JHA's mailing list
Join today to receive communications including JHA reports and public statements
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Comments, if any
Tribute Information
Is this a tribute gift?
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If yes, you will be able to select who it is in honor of or in memory of in the next step.
No
Yes, in Honor of
Yes, in Memory of
Name of the person this tribute gift is honoring
First Name
Last Name
May we notify the honoree of your gift?
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No
Honoree's Email
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Name of the person this tribute gift is remembering
First Name
Last Name
May we notify a friend or family member of your gift?
Yes
No
Name of family member or friend to be notified
Friend or Family Member's Email
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